Massage.
Physiology of massageDraft

Circulation and blood flow

Massage warms and reddens the skin, but good studies do not show that it increases blood flow into the muscles underneath.

Evidence
limited

Small laboratory studies agree that massage raises skin blood flow and skin temperature. The same studies found no rise in arterial (femoral) blood flow after leg massage, and one found that massage slowed blood flow and lactate removal from forearm muscles compared with passive rest. Evidence for the popular claim that massage "boosts circulation" in any meaningful way beyond the skin is weak, and the evidence that exists partly points the other way.

Effects

  • Local reddening and warmth of the skin where massage is applied
  • A short-term rise in skin blood flow and skin temperature in the massaged area
  • No clear increase in arterial or muscle blood flow in controlled studies
  • Clients commonly report feeling warm and "loosened up"

What happens

When you massage an area, the skin often becomes pink and warm. This is called hyperaemia (increased blood in the small vessels near the surface). It comes from friction, pressure and local reflexes that widen skin blood vessels. It is real and visible, and it is part of why Effleurage feels warming.

What the research does and doesn’t show

Older textbooks often say massage “increases circulation” to the muscles and so speeds recovery. When researchers measured blood flow directly with ultrasound, the picture was different:

  • Leg massage after exercise raised skin blood flow and temperature, but not the blood flow in the main artery supplying the thigh, and not muscle temperature.
  • Forearm massage after hard gripping exercise actually reduced blood flow and the removal of lactate from the muscle compared with simply resting. The researchers suggest the pressure of the strokes mechanically gets in the way of flow.

These are small studies, so the honest conclusion is that massage has not been shown to improve deep muscle circulation, and may not.

How to talk about it with clients

  • Say: “You might notice the skin looks a bit pink and feels warm. That’s normal.”
  • Avoid: “This will boost your circulation” or “This flushes out lactic acid.” See What massage research does and doesn't show for why the “flushing” idea is not supported.

Increased blood flow is not needed to explain why massage feels good. Most of the well-supported effects are on how people feel (see Psychological effects of massage and Relaxation and the parasympathetic response).

Sources

  1. Hinds T et al. (2004). Effects of massage on limb and skin blood flow after quadriceps exercise. Med Sci Sports Exerc 36(8):1308–1313 (Massage raised skin blood flow and skin temperature but not femoral artery blood flow or muscle temperature.)
  2. Wiltshire EV et al. (2010). Massage impairs postexercise muscle blood flow and "lactic acid" removal. Med Sci Sports Exerc 42(6):1062–1071 (Effleurage and petrissage reduced forearm blood flow and lactate removal compared with passive rest.)
  3. Weerapong P, Hume PA, Kolt GS (2005). The mechanisms of massage and effects on performance, muscle recovery and injury prevention. Sports Med 35(3):235–256 (Narrative review of proposed mechanisms, including blood flow; notes the limited supporting data.)